Insurer says it shouldn’t have to pay for medical marijuana

AUGUSTA, Maine _ The Maine supreme court on Wednesday began considering whether a paper millworker left suicidal by narcotic painkillers should receive workers’ compensation for medical marijuana.

It’s the first time the court has considered the question of insurance reimbursement for medical marijuana.

Madawaska resident Gaetan Bourgoin won a ruling from the state’s Workers’ Compensation Board two years ago saying the paper mill’s insurer must reimburse him for medical marijuana. He contends marijuana is cheaper and safer than narcotics.

But Twin Rivers Paper Co. and its insurer appealed the ruling, arguing that paying for pot use, even for medical purposes, could expose the companies to prosecution since marijuana still is illegal at the federal level.

With medical marijuana legal in Washington, D.C. and 29 states, insurers across the country have been confronted with the same dilemma. Uneven state laws on reimbursement further complicate the issue.

Five states Connecticut, Maine, Minnesota, New Jersey and New Mexico have found medical marijuana treatment is reimbursable under their workers compensation laws, according to the National Counsel for Compensation Insurance. Florida and North Dakota, meanwhile, passed laws this year excluding medical marijuana treatment from workers’ compensation reimbursement.

Members of the Maine Supreme Judicial Court posed hypotheticals to the attorneys arguing the case. One asked Bourgoin’s attorney what he’d do if a client needed cocaine for pain treatment, and another asked Twin Rivers’ attorney whether she believes the federal government will start prosecuting insurers for medical marijuana reimbursement.

Justice Donald Alexander repeatedly questioned whether marijuana use should remain illegal under federal law and contrasted the drug with opioid-based painkillers, which he said drug companies have lobbied Congress to protect.

“Opioids are killing people every day in Maine,” he said.

Bourgoin’s case dates to 1989, when he hurt his back as a 29-year-old at the paper mill now known as Twin Rivers.

His attorney, Norman Trask, said Bourgoin pays for medical marijuana out-of-pocket and receives reimbursement from Twin Rivers’ insurer. Bourgoin previously took opioid-based painkillers, which caused other problems.

“At one point he was on such high dosages that they were concerned about his oxygen levels at night,” Trask said. “He became suicidal.”

Twin Rivers attorney Anne-Marie Storey said paying for medical marijuana puts the company in violation of federal law. The company contends that Maine’s medical marijuana law does not explicitly require an insurer to cover the cost of medical marijuana.

“This is not a case about making judgment over whether someone should use or not use marijuana as a matter of personal choice,” she said. There’s a scarcity of research on medical marijuana, and “nobody knows” how safe it is, she said.

Medical-marijuana grower funds legal fight for insurance coverage

One of Canada’s largest medical-cannabis producers says it will fund a Nova Scotia man’s ongoing legal fight to have his marijuana prescription paid for by his employee-insurance plan – the latest move in a nationwide push by industry, patients and their advocates for more widespread cannabis coverage.

Aurora Cannabis Inc., a publicly traded grower based in Alberta, announced this week that it will bankroll elevator mechanic Gordon Skinner’s coming defence this fall in the Nova Scotia Court of Appeal.

Aurora executive vice-president Cam Battley said the original ruling, by Nova Scotia’s human-rights board last year that found Mr. Skinner’s medicine should be covered, should extend to other patients with similar plans.

“Patients have access to insurance reimbursement for a very broad range of prescription medicines,” Mr. Battley said. “Patients can get reimbursement through their insurance programs for opioids – and you know that we have an opioid crisis in this country.

“When medical cannabis can provide an alternative and, in some cases, a safer alternative, it does make sense that it be treated the same way as other prescription products.”

In Canada, only veterans, some first responders and a small number of private citizens get their medical cannabis covered by health-insurance providers. That’s because Health Canada has not approved marijuana as a medicine, so insurers are less inclined to offer coverage.

John Conroy, an Abbotsford-based lawyer who was involved in a case that forced Health Canada to rewrite its medical-marijuana rules last year, said, if it stands, the Nova Scotia ruling could set a precedent for patients seeking coverage in other provinces with similar human-rights laws.

“The ruling is saying the insurance company mustn’t discriminate on the basis of a drug,” he said. “So, they’re providing coverage for people with chronic pain who want opiates that could kill them, but they won’t provide coverage for cannabis, which won’t kill them.”

Mr. Skinner successfully argued his own case before Nova Scotia’s human-rights board last October after being denied coverage for cannabis three times by his insurer, the Canadian Elevator Industry Welfare Trust Plan.

Mr. Skinner, from a community just outside Halifax, had argued that he faced discrimination when he was denied coverage for medical cannabis to treat chronic pain from an on-the-job car accident that forced him to retire years ago.

The provincial inquiry-board chair found that Mr. Skinner’s plan unintentionally discriminated against him by not paying for his cannabis because it required a doctor’s prescription.

The ruling stated that the insurance plan contravened the province’s Human Rights Act, and must now cover his medical-marijuana expenses “up to and including the full amount of his most recent prescription.”

The board found that Mr. Skinner’s chronic pain has been undermanaged as a result of the denial of coverage, resulting in “profoundly negative effects on the complainant and his family.”

The trustees of Mr. Skinner’s plan have appealed the ruling and a hearing is set for Oct. 2. Mr. Battley said his company would continue supporting Mr. Skinner if that ruling is appealed to the Supreme Court of Canada.

Jonathan Zaid, head of the patient advocacy group Canadians for Fair Access to Medical Marijuana, said the exclusion of cannabis coverage from many people’s plans hinges on the drug not having been issued a unique number by Health Canada that identifies its manufacturer, product name, active ingredients, strength, pharmaceutical form and route of administration.

He also said he and other patient advocates were disappointed Ottawa made no mention of how it would increase the affordability of medical cannabis when it recently unveiled its legalization framework.

Advocates and licensed producers have long called on Canada to remove sales tax on medical cannabis, just like it has for other prescription drugs.

Loblaw is covering medical marijuana for workers. Will other employers follow?

By Solomon Israel, CBC News

At first glance, the news was “actually pretty stunning.”

Joan Weir, director of health and disability policy with the Canadian Life and Health Insurance Association, was surprised to see that Canadian retail giant Loblaw Companies had started covering medical marijuana for employees through their health benefit plans back on March 28.

After taking a closer look at the limitations of Loblaw’s coverage, Weir said her astonishment diminished somewhat. The company is only covering medical marijuana used to treat the symptoms of multiple sclerosis, as well as the side-effects of chemotherapy for cancer patients, and only up to $1,500 per year.

“I don’t think it’s a game-changer yet,” she said.

Still, Weir said Loblaw is now the first large Canadian employer to cover medical marijuana under a benefits plan.

As the federal government charges towards legalization, Loblaw’s move hints at a possible future trend in employee insurance benefits.

45,000 employees covered

It’s not hard to imagine why Loblaw might be willing to cover medical marijuana: the company’s Shoppers Drug Mart division has applied to Health Canada for the licence needed to sell legal medical marijuana.

In a statement, Loblaw spokesperson Tammy Smitham said the company was “adapting to changes in the area of drug therapies.”

“More robust clinical evidence supporting the use of medical marijuana as a treatment for some specific conditions has emerged and we felt the time was right to make this addition to our benefits plan,” said Smitham.

About 45,000 Loblaw employees will be covered under their plans, Smitham said, although the company doesn’t know how many employees use medical marijuana. Insurance benefits for Loblaw workers and Shoppers Drug Mart administrative employees are managed by Manulife, and Shoppers Drug Mart store staff are covered by Great West Life.

According to Health Canada, 142,541 people were registered to buy medical marijuana from government-licensed producers as of Jan. 31.

An insurance perspective

​Medical marijuana will have to clear some significant regulatory hurdles before it becomes a regular health insurance benefit, according to private health plan strategist Suzanne Lepage.

Usually, said Lepage, insurers won’t cover a drug until it has passed clinical trials, been approved by Health Canada and assigned a drug identification number (DIN). Some individual medical marijuana users areurging the federal agency to assign a DIN for dried marijuana for medical purposes.

“Until that happens, it doesn’t even get in the queue to be considered,” said Lepage.

After that, insurance providers run a cost-benefit analysis to determine whether the drug is worth covering. Even though medical marijuana doesn’t yet meet insurers’ regular criteria, said Lepage, large employers like Loblaw can ask for extra-contractual provisions to administer coverage — if they’re willing to take on the cost.

‘A great first step’

Loblaw’s decision to start covering medical marijuana is “a great first step for the industry,” said Deepak Anand, executive director of the Canadian National Medical Marijuana Association.

Even so, Anand sees Loblaw’s $1,500 per year coverage limit as “quite low.” An annual limit of $5,000 would be more appropriate, he said.

“If you look at the costs that patients end up paying, it’s only going to cover them about six months, whereas it’s supposed to last them a year or so,” he said.

According to Anand, the landscape for insurance coverage of medical marijuana is already changing.

In 2017, a Nova Scotia human rights board ruled that Gordon Skinner’s employee insurance plan had to cover his prescribed medical marijuana. In 2016, University of Waterloo student Jonathan Zaid convinced his student union to cover his prescription. Veterans Affairs Canada also covers the cost of medical marijuana for Canadian military veterans.

For now, Anand says the Canadian National Medical Marijuana Association has been fielding lots of calls from insurance companies who want to talk about medical marijuana.

Employer concerns

Insurance companies and their clients aren’t just worried about the cost and effectiveness of medical marijuana, according to Joan Weir of the Canadian Life and Health Insurance Association. They’re also trying to figure out how it will fit into the workplace.

She said covering medical marijuana brings complications related to “having medical marijuana at work, having it used at work, having impairment at work, all of those sorts of issues that employers would have to deal with if they were to add it on.”

Those complications are even trickier in fields where industrial safety is a concern, she said.

More research into the effects of medical marijuana could help mitigate some of those fears, said Weir. But in the near future, she said, the uptake of medical marijuana coverage under employee benefit plans is “going to be slow.”

Health Canada urged to clear way for medical pot insurance

Health Canada urged to clear way for medical pot insurance

By Andrea Huncar, CBC News

Now she has another worry.

“It’s costing a pretty penny,” she said. “So what I do is I under-medicate greatly. I scrimp and I save and I only use it very sparingly.”

Like most Canadians, Grindle’s standard insurance plan doesn’t cover legally prescribed cannabis. For Grindle that adds up to $1,200 a month if she were to use her full four-gram daily allowance, so she gets by on one gram a day.

As the federal government prepares to legalize recreational marijuana by July 2018, Grindle is among the advocates calling on Health Canada  to clear the way for coverage of legally-prescribed pot.

With the exception of limited coverage for veterans and patients with health care spending accounts, the standard insurance of most Canadians doesn’t reimburse the cost of medical cannabis.

Kait Shane, director of community outreach with Calgary-based Natural Health Services, describes it as the “missing link,” noting Canadians can claim cannabis on their their tax returns and travel with it on federal flights.

“Every patient comes in and is kind of wondering the same thing. Can we be covered; will we be covered?” said Shane, whose Calgary-based company prescribes cannabis at several western locations including Edmonton.

She said the problem is that medical marijuana doesn’t have a drug identification number (DIN); a classification that requires going through a rigorous, expensive approval process required of all new drugs.

Kait Shane with Natural Health Services says out-of-reach cannabis prices push some patients to illegal sources.

“It’s a matter of lobbying … to get Health Canada to recognize it’s not feasible for them to go through the same trials as other drugs,” said Shane, who points out that unlike other narcotics, cannabis has been used for a long time.

Shane worries not insuring medical cannabis will alienate those who can’t afford to get it through licensed producers.

“High costs currently push many patients to seek alternative options through illegal avenues with zero testing protocols,” she said. “The lack of testing could put a patient’s health at risk.”

Joan Weir, director of health police at the Canadian Life and Health Insurance Association, said the process is moving slowly, despite some employers adding coverage.

“There’s not a lot of good research on the impact of adding medical marijuana to your drug program,” said Weir. “So there needs to be a fair bit more research to make employers comfortable on including it as a benefit.”

Health Canada wasn’t immediately available for comment.

Human rights board says Nova Scotia man’s medical marijuana must be insured

A Nova Scotia human rights board has ruled a Halifax-area man’s prescribed medical marijuana must be covered by his employee insurance plan.

Gordon “Wayne” Skinner, of Head of Chezzetcook, had argued that he faced discrimination when he was denied coverage by the Canadian Elevator Industry Welfare Trust Plan.

The former elevator mechanic with ThyssenKrupp Elevator Canada suffers from chronic pain following an on-the-job motor vehicle accident in August 2010, and has been unable to work.

In a written decision released February 3, 2017, inquiry board chair Benjamin Perryman concluded the insurance plan includes conditions for coverage and since medical marijuana requires a prescription by law, it doesn’t fall within the plan’s exclusions.

Perryman ruled the Canadian Elevator Industry Welfare Trust Plan contravened the province’s Human Rights Act in denying Skinner coverage, and must now cover his medical marijuana expenses “up to and including the full amount of his most recent prescription.”

The ruling states the medical marijuana must be purchased from a producer licensed by Health Canada or a person legally authorized to produce for Skinner under the Access to Cannabis for Medical Purposes Regulations.


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